Acute mesenteric ischemia following cardiac surgery.
BACKGROUND
The results of surgical intervention for acute mesenteric ischemia following major cardiac surgery were analysed.


METHODS
Retrospective investigation. Setting. University Hospital of Hannover Medical School.


METHODS
Eleven patients (five women and six men) amongst a total of 90 patients operated from 1972 to 1993 because of an acute splanchnic ischemia. This subgroup represented 12%. The causes of splanchnic ischemia were arterial embolism in 55% and nonocclusive disease in 45%.


METHODS
Surgical intervention comprised embolectomy in one patient (9%), bowel resection in 36% and exploratory laparotomy only in 55%.


METHODS
Hospital mortality, causes of death and long term survival were analysed.


RESULTS
The inhospital mortality of the 11 patients was 91% and only one female patient with arterial embolism survived after bowel resection. In the 79 patients without previous cardiac surgery the postoperative mortality of mesenteric ischemia was significantly (p<0.001) lower with 62%.


CONCLUSIONS
Following cardiac surgery mesenteric infarction is a rare complication with an incidence of 0.06% and the chance of survival is minimal. Whenever acute abdominal disease occurs after cardiac surgery, the differential diagnosis should include mesenteric ischemia. Only an immediate surgical intervention with revascularisation and/or removal of gangrenous bowel segments may eventually improve the patient's prognosis.
Klempnauer
J
J
Department of Abdominal and Transplantation Surgery, Medical School Hannover, Germany.
Grothues
F
F
Bektas
H
H
Wahlers
T
T
D000208:Acute Disease; D000368:Aged; D006348:Cardiac Surgical Procedures; D004617:Embolism / Q000209:etiology; D005260:Female; D006801:Humans; D007238:Infarction / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D008297:Male; D008638:Mesenteric Arteries; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013152:Splanchnic Circulation